1

Using Using

EvidenceEvidence--Based Medical Based Medical

ResourcesResources

FSU College of MedicineFSU College of Medicine

20142014——20152015

Nancy Clark, M.Ed.Nancy Clark, M.Ed.

Dan Van Durme, M.D.Dan Van Durme, M.D.

2

Table of Contents

Topic Page

Accessing Library Resources Off Campus using EZProxy 3

Evidence Based Medicine Links on the Library and

Informatics Websites

4

The EBM Process 5-6

Level of Evidence and Strength of Recommendation 7-8

Major EBM Databases (Foraging Tools) 9-10

Making EBM Databases Usable at the Point of Care:

The Hunting Tools

11

ACP Smart Medicine—Web Version 12

Clinical Evidence—Mobile Version Highly respected, EBM tool, published by the BMJ. Summarizes the current state of knowledge and uncertainty about the prevention and treatment of clinical conditions. For each of the 200 or so clinical conditions in the reference, recommendations are summarized as Beneficial, Likely to be beneficial, Trade off between benefit and harm, Unlikely to be beneficial, Harmful.

13-14

Clinical Evidence—Web Version 15

Essential Evidence Plus—Web version Includes the

Cochrane Abstracts InfoPOEMS EBM Guidelines Clinical Practice Guidelines Clinical Rules and Calculators

16-18

Essential Evidence Plus—Mobile Version 19-22

DynaMed—Web version Huge disease, condition and medical topics database that systematically surveys the literature for latest information.

25-26

DynaMed—Mobile version 27

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Off Campus Access to the Virtual Medical LibraryOff Campus Access to the Virtual Medical Library

From off campus to use the Library resources you must do the From off campus to use the Library resources you must do the

following:following:

1. Click on the EZProxy red button at the top of Library page:

www.med.fsu.edu/library.

2. Then, click the Login to College of Medicine EZProxy button.

a. Type your FSU COM UserID and Password in the blanks provided

(firstname.lastname). If you do not know your FSU COM UserID and Password, contact the IT

helpdesk (644-3664) OR regional campus ET staff: Orlando: Claudin Pierre-Louis (407) 835-4103 x405 Pensacola: Chris Clark (850) 494-5939 x125

Tallahassee: Mark Hughes (850) 645-1257 Sarasota: Chip Orth (941) 316-8120 x311

Ft Pierce: David Thoreson (772) 464-0034 x503 Daytona Beach: Bijan Fallahi (386) 252-0601 Main Campus: Help Desk (850) 644-3664

3. If you get a security messages, just click YES. This site is safe.

4. This takes you back to the Library Homepage. Notice that all URLs now contain

the phrase: ". . . ezproxy.med.fsu.edu/."

You must follow links from the Library page to get to resources and make sure this phrase stays in the URL. If it links you out, and that phrase vanishes, you are no longer connected to EZProxy. You will know you are kicked out of

the proxy if a site asks you for a UserID and Password. If you think this should not have happened (you didn’t manually type in a link, etc.) contact the

Medical Library immediately. We have discovered some sites that do this and have fixed them as they are brought to our attention.

4

Evidence Based Medicine Links

On the Library Web Site look under Clinical Tools for

EBM Tools. Expand that to see Summaries, Guide-lines, Reviews of the Literature, and Instructionsal.

Click on any of these to go to the EBM Tools pages.

EBM Tools Section of the New Library site

5

The Evidence Based Medicine Process The Evidence Based Medicine Process

The most current and widely accepted definition of evidence-based medicine is “the

integration of the best research evidence with clinical expertise and patient values.” This

reflects a systematic approach to clinical problem solving.

The following diagram illustrates this systematic process for implementing evidence based

medicine into clinical practice:

1. The

patient

1. Start with the patient -- a clinical problem or question arises out of the

care of the patient

2. The

question

2. Construct a well built (PICO) clinical question derived from a

patient case, and identify the Patient, population, or problem, the

Intervention being considered, the Comparison you are considering, if

any, and the desired Outcome you would want, then identify the type

of question: background, diagnosis, treatment/prevention, prognosis

or harm

Examples of PICO questions:

Therapy Question

In patients with migraine headaches without auras, is Depakote

more effective than Inderal for prophylaxis of headaches?

Prognosis Question

In diabetic patients with foot ulcers, is the diagnosis of

osteomyelitis with MRI as predictive of healing as an audible pulse

on Doppler examination?

Diagnosis Question

In geriatric patients with suspected carotid stenosis, is duplex

ultrasound as good as magnetic resonance angiography in

detecting significant carotid stenosis?

Harm Question

For pregnant patients, does the consumption of large amounts of

coffee, (compared to non-coffee drinkers) increase the rate of

spontaneous abortion?

6

3. The

resource

3. Select the appropriate resource and conduct a search. Go to the

appropriate topic which is then broken down for you into categories:

diagnosis, treatment, prognosis, prevention/screening…

Attempt to find the best evidence with the highest quality and

reliability first, such as a Cochrane review or POEM review of a study.

If not available, drill down to an expert opinion level resource, such

as a textbook or manual. As a last resort with time permitting,

search Medline, find a full text article, and review it yourself for

validity, rigor and study design.

4. The

evaluation

4. Appraise that evidence for its validity (closeness to the truth) and

applicability (usefulness in clinical practice). Look for the Level of

Evidence or Strength of Recommendation provided by the

resource selected. See next page for explanation of these terms.

5. The

patient

5. Return to the patient -- integrate that evidence with clinical

expertise, patient preferences and values and apply it to practice.

6. Self-

evaluation

6. Evaluate your performance — How can you be more efficient in the

future? For example: Was it a vague question? Did you use optimal

resources?

The Evidence Based Medicine Process continuedThe Evidence Based Medicine Process continued

Sackett DL, Strauss SE, Richardson WS, et al. Evidence-based medicine: how to practice and teach EBM. 2nd Ed. London: Churchill-Livingstone,2000

7

“Level of Evidence” (LOE) and “Level of Evidence” (LOE) and

“Strength of Recommendation” (SOR) Scales“Strength of Recommendation” (SOR) Scales

DefinitionsDefinitions

Level of Evidence (LOE): The validity of an individual study based on an assessment of

its study design. The essence of levels of evidence is that, in general, controlled studies

are better than uncontrolled studies, prospective studies are better than retrospective

studies, and randomized studies are better than nonrandomized studies.1

Strength of Recommendation (SOR): The strength of a recommendation for clinical

practice (guideline, etc.) based on a body of evidence, usually based on more than one

study. This takes into account the level of evidence of individual studies; the type of

outcomes measured by these studies (patient-oriented or disease-oriented); the number,

consistency, and coherence of the evidence as a whole; and the relationship between

benefits, harms, and costs.1

How are these Assigned?How are these Assigned?

A LOE or SOR is assigned to a specific recommendation, guideline, or research article by

one or more experts in the field of research design and critical appraisal of the literature

working for either a journal, an association, or medical reference like ACP Smart Medicine

or DynaMed using a carefully defined criteria. Most LOE scales, like the one Essential

Evidence Plus uses, are roughly based on the scale developed by the Oxford Centre for

Evidence Based Medicine. http://www.cebm.net There are different criteria for each type

of recommendation: therapy, diagnosis, prognosis, etc. (below) The SOR scales used by

various EBM resources are listed on the next page for comparison.

1. Ebell MH, Siwek J, Weiss BD, et al. Strength of recommendation taxonomy (SORT): a patient-centered approach to grading evidence in the medical literature. Am Fam Physician. Feb 1 2004;69(3):548-556.

OCEBM Levels of Evidence Working Group. "The Oxford 2011 Levels of Evidence". Oxford Centre for Evidence-Based Medicine. http://www.cebm.net/index.aspx?o=5653

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Strength of Recommendation Scales

ACP Smart Medicine USPSTF EE+ DynaMed

A A. the preponderance of

data supporting this statement is derived from level 1 studies, which meet all of the evidence criteria for that study type

A. There is good evidence to

support the recommendation that the condition be specifically considered in a periodic health examination

A. There is good

research-based evidence to support the recommendation.

A. Consistent

high-quality evidence

B B. the preponderance of data

supporting this statement is derived from level 2 studies, which meet at least one of the evidence criteria for that study type

B. There is fair evidence to

support the recommendation that the condition be specifically considered in a periodic health examination.

B. There is fair

research-based evidence to support the recommendation.

B. inconsistent

or limited evidence

C C. the preponderance of data

supporting this statement is derived from level 3 studies, which meet none of the evidence criteria for that study type or are derived from

expert opinion, commentary or consensus

C. There is insufficient evidence

to recommend for or against the inclusion of the condition in a periodic health examination, but recommendations may be made on other grounds.

C. The

recommendation is based on expert opinion and panel consensus.

C. lacking

direct evidence

D. There is fair evidence to

support the recommendation that the condition be excluded from consideration in a periodic health examination.

X. There is

evidence of harm from this intervention

I. There is good evidence to

support the recommendation that the condition be excluded from consideration in a periodic health examination.

Level of Evidence or Strength of Evidence Scales

DynaMed

1 Level 1 (likely reliable) Evidence - representing the most valid reports addressing patient-oriented

outcomes. Examples include rigorous randomized trials, inception cohort studies for prognostic information, and systematic reviews of level 1 evidence reports.

2 Level 2 (mid-level) Evidence - representing reports addressing patient-oriented outcomes, and using

some method of scientific investigation, yet not meeting the quality criteria to achieve level 1 evidence labeling. Examples include randomized trials with less than 80% follow-up, non-randomized comparison studies, and diagnostic studies without adequate reference standards. Level 2 evidence does not imply reliable evidence.

3 Level 3 (lacking direct) Evidence - representing reports that are not based on scientific analysis of

patient-oriented outcomes. Examples include case series, case reports, expert opinion, and conclusions extrapolated indirectly from scientific studies.

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Major EBM DatabasesMajor EBM Databases——(Foraging Efforts)(Foraging Efforts)

A high-quality foraging tool employs a transparent process that

1. Systematically surveys or reviews the literature 2. filters out disease-oriented research and presents only patient-oriented research

outcomes 3. demonstrates that a validity assessment has been performed using appropriate

criteria 4. assigns levels of evidence, based on appropriate validity criteria, to individual

studies 5. provides specific recommendations, when feasible, on how to apply the information,

placing it into clinical context 6. comprehensively reviews the literature for a specific specialty or discipline 7. coordinates with a high-quality hunting tool

Slawson DC, Shaughnessy AF. Teaching evidence-based medicine: should we be teaching information management instead? Acad Med. 2005 Jul;80(7):685-9.

Cochrane Database of Systematic Reviews The Cochrane Collaboration is an

international non-profit and independent

organization, dedicated to making up-to-date,

accurate information about the effects of

healthcare readily available worldwide. It

produces and disseminates systematic reviews

of healthcare interventions and promotes the

search for evidence in the form of clinical trials

and other studies of interventions. The

Cochrane Collaboration was founded in 1993

and named for the British epidemiologist, Archie

Cochrane.

The major product of the Collaboration is the

Cochrane Database of Systematic Reviews

which is published quarterly as part of The

Cochrane Library. Members of the Collaboration

systematically review the entire English

publications on a topic. Abstracts are free at their

website. Full text is available through Wiley Interscience. (see link on library web

page). Cochrane Systematic Reviews on therapy topics only contain randomized clinical

trials.

Those who prepare the reviews are mostly health care professionals who volunteer to

work in one of the many Collaborative Review Groups, with editorial teams overseeing the

preparation and maintenance of the reviews, as well as application of the rigorous quality

standards for which Cochrane Reviews have

become known.

ACP Journal Club

Critical appraisals of studies from two

journals, the ACP Journal Club and Evidence

Based Medicine. ACP Journal Club's general

purpose is to select from the biomedical literature

articles that report original studies and systematic

reviews that warrant immediate attention by

physicians attempting to keep pace with

important advances in internal medicine. These

articles are summarized in value-added abstracts

and commented on by clinical experts.

http://www.cochrane.org

http://www.acpjc.org

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Daily POEMS

Patient Oriented Evidence that Matters.

Published daily, and ongoing since 1996, editors

review more than 1,200 studies monthly from

100+ medical journals, presenting only the best

as InfoPOEMs. The acclaimed POEMs process

applies specific criteria for validity and relevance

to clinical practice. About 1 in 40 studies

reviewed qualifies for inclusion.

Database of Abstracts of Reviews of

Effectiveness DARE contains summaries of systematic

reviews which have met strict quality criteria.

Included reviews have to be about the effects

of interventions. Each summary also provides

a critical commentary on the quality of the

review. The database covers a broad range

of health and social care topics and can be

used for answering questions about the

effects of interventions, as well as for

developing guidelines and policy making.

(DARE) is currently available through Ovid.

National Guideline Clearinghouse A public resource for evidence-based

clinical practice guidelines. NGC is an

initiative of the Agency for Healthcare

Research and Quality (AHRQ), U.S.

Department of Health and Human Services.

NGC was originally created by AHRQ in

partnership with the American Medical

Association and the American Association of

Health Plans (now America's Health

Insurance Plans [AHIP]).

US Preventative Services Task

Force (USPSTF)

The USPSTF, first convened by the U.S.

Public Health Service in 1984, and since

1998 sponsored by the Agency for Healthcare

Research and Quality (AHRQ), is the leading

independent panel of private-sector experts

in prevention and primary care. The USPSTF

conducts rigorous, impartial assessments of

the scientific evidence for the effectiveness of

a broad range of clinical preventive services,

including screening, counseling, and

preventive medications. Its recommendations

are considered the "gold standard" for clinical

preventive services.

http://www.essentialevidenceplus.com/

http://www.crd.york.ac.uk/crdweb/

http://www.guidelines.gov

http://www.ahrq.gov/clinic/uspstfix.htm

11

EBM Hunting Tools combine many of the major EBM foraging tools into one tool that

searches multiple resources, then organizes the results by category representing the type

of question you have. The chart above summarizes the tools that can be found in Essential

Evidence Plus, DynaMed and Wiley. Wiley currently contains the full text versions of the

Cochrane Reviews, plus DARE. Each of the following are available on the web and all

except ACP Smart Medicine are available on the mobile device for all CoM faculty and

students:

ACP Smart Medicine The ACP Smart Medicine is an evidence-based "System" of

actionable information about health conditions and

interventions. It builds on other ACP-ASIM publications

including ACP Journal Club and MKSAP, enabling users to

drill down to the evidence-synopses supporting recommendations. Clinical Evidence

Evidence-based evaluations of interventions for common

clinical conditions developed in collaboration with the

American College of Physicians, the American Society of

Internal Medicine and BMJ.

Essential Evidence Plus (EE+)

Includes the Cochrane abstracts, InfoPOEM reviews,

guidelines, USPSTF recommendations, clinical prediction

tools, 5 Minute Clinical Consult, Coding tools, images, and

much more.

DynaMed

DynaMed contains clinically organized summaries of nearly

3,200 topics and is updated daily from review of the

research literature. Links out to specific articles. It also

includes the Cochrane abstracts, ACP Journal Club,

guidelines, USPSTF recommendations, POEMs, their own

reviews, as well as extensive background materials.

Making EBM Databases Usable at the Point of Care: Making EBM Databases Usable at the Point of Care:

The Hunting ToolsThe Hunting Tools

12

ACP Smart MedicineACP Smart Medicine ACP Smart Medicine is an evidence based, decision-support tool designed for rapid point-of

-care delivery of up-to-date guidance for clinicians. Formatted for viewing on a mobile

device, information in Smart Medicine is presented in a "drill down" format, in which the

user clicks from an opening guidance statement through to more specific information.

DiseaseDisease--based Modulesbased Modules

The disease-based modules are Smart

Medicines's core. Each module presents

summaries of the evidence on each topic

for prevention, screening, diagnosis,

therapy, and consultation. There are links

to abstracts and the full text of carefully

selected references; to Clinical

Pharmacology drug resource; other ACP

knowledge resources including its

guidelines, MKSAP, Annals of Internal

Medicine, and ACP Journal Club; and other

resources including PubMed and various

Web sites. Tables, figures, algorithms, and

video and audio clips are also included.

TablesTables

One of the most useful aspects of Smart

Medicine are the tables that display

recommendations. Each disease module

includes five standard tables (history and

physical examination, laboratory and other

studies, differential diagnosis, drug treatment,

and elements of follow-up).

Here you can see

the module on

Migraine. By

following the

links down, you

can see the table for

Laboratory and other

Studies as well as a table

of Acute Drug Treatment.

13

Clinical Evidence Clinical Evidence -- iPhone VersioniPhone Version

Clinical Evidence is a highly respected, evidence-based medicine tool, pub-

lished by the British Medical Journal. It summarizes the current state of

knowledge and uncertainty about the prevention and treatment of clinical con-

ditions, based on thorough searches and appraisal of the literature. It is nei-

ther a textbook of medicine nor a set of guidelines. It describes the best avail-

able evidence from systematic reviews, RCTs and observational studies where

appropriate, and if there is no good evidence it says so. For each of the 200 or so clinical

conditions in the reference, the literature is systematically reviewed. Recommendations

are summarized into the following categories:

Using Osteoarthritis of the Knee as our example,

you can search the Topic Index or use Contents

and drill down to a topic inside the classification/

organ system, Musculoskeletal. The topic opens up to

the Treatment Summary section which is organized like

the table above.

4/21/05

Opening Screen Tap on Clinical Evidence

1

14

Key Points Background

Treatment Summary

Monographs are actually

one long page, so you can scroll down. The Pop-up

box in the bottom right corner will take you quickly to one of the other sec-

tions. Background information

on each condition is almost a complete disease refer-ence with epidemiology,

etiology, diagnosis, prog-nosis, outcomes and goals

information. Key Points nicely sum-

marizes the condition and

treatment options. Tap an option to read a

monograph about that op-tion. At left is the details

on the option for Topical Steroids with a Summary and considerations, harms,

benefits discussion.

Clinical Evidence Clinical Evidence -- iPhone Version continuediPhone Version continued

Contributors

15

Clinical Evidence Clinical Evidence -- Web VersionWeb Version

The web version of Clinical Evidence is also in the uCentral resource. Look up the topic via

Contents by type of condition, or use the Topic Index to locate your topic alphabetically.

1

Each recommendation is linked to detailed

information on the studies found in support

of their recommendation.

16

Essential Evidence PlusEssential Evidence Plus——Web VersionWeb Version

104 journals surveyed for Evidence-Based Practice Newsletter

Over 1300 article synopses/ POEMS

Cochrane abstracts

Selected evidence-based guidelines (USPSTF, CDC, JNC7,others)

Basic drug info

Clinical calculators/prediction rules

Search Or Browse for topic

Resources

17

Essential Evidence PlusEssential Evidence Plus——Web VersionWeb Version

Searching or browsing will eventually require browsing down to answer your

question. Here is an example:

Sample Question Do survivors of childhood cancers like

leukemia have an increased risk of developing

other cancers?

Type of question: Prognosis

1. Select subject area Neoplasms or

search for leukemia

2. Under Type of Result,

select Prognosis

4. Select appropriate

item

InfoPOEM

POEM stands for

“patient oriented evidence that matters”

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FSU link to full text

article

Web Version of Essential Evidence

Plus links out to multiple respected resources such as:

PubMed with links to full text articles

National Guidelines Clearinghouse

Patient Education Handouts at

FamilyDoctor.org

Link to PubMed

Linked to Guidelines.gov Guidelines

National Guidelines Clearinghouse at www.guidelines.gov

19

The Evidence Based Medicine Process Using Essential The Evidence Based Medicine Process Using Essential

Evidence Plus Mobile Formatted VersionEvidence Plus Mobile Formatted Version

The Steps in the EBM Process

Method 1. Search the Essential Evidence Plus collection

for Migraine.

2. Tap Refine Results and scroll for Treatment. Select Drug

Treatment.

Continued on next page...

The patient 1. Start with the patient -- a clinical problem or question arises out of

the care of the patient

The question 2. Construct a well built (PICO) clinical question derived from a

patient case , and identify the Patient or problem, the

Intervention being considered, the Comparison you are

considering, if any, and the desired Outcome you would want,

then identify the type of question: background, diagnosis,

treatment/prevention, prognosis or harm

The resource 3. Select the appropriate resource (EE+) and conduct a search. Go

to the appropriate topic which is then broken down for you into

categories: diagnosis, treatment…

The evaluation 4. Appraise that evidence for its validity (closeness to the truth) and

applicability (usefulness in clinical practice). Essential Evidence

Plus provides the Level of Evidence for every resource using one

of the four taxonomies:

Centre for Evidence-Based Medicine, Oxford (1a-5)

SORT: Strength-of-Recommendation Taxonomy (A,B,C)

GRADE: Grading of Recommendations Assessment,

Development and Evaluation (A,B,C,D)

Practice Guidelines rading scales (various)

5. Tap the level of evidence [SORT 2]to go to a page that explains

these.

The patient 5. Return to the patient -- integrate that evidence with clinical

expertise, patient preferences and apply it to practice. Many of

Essential Evidence Plus’s clinical decision rules are useful within

the patient interaction.

Self-evaluation 6. Evaluate your performance with this patient

Sample Question In patients with migraine headaches without

auras, is divalproex (Depakote) more effective

than Inderal for prophylaxis of headaches?

P = patients with migraines without auras

I = Depakote (divalproex sodium)

C = Inderal (propanolol)

O = prophylaxis of headaches

Type of question: Tx: Drug Treatment

1.1.

2.2.

20

3. Review results titles for

appropriate reference.

[Advance page if none are

on first page.]

4. Read resource. Note Level

of Evidence on likely re-

source.

Essential Evidence Plus: Browse Selected ResourceEssential Evidence Plus: Browse Selected Resource Select a specific database when you have a specific need, such as using a calculator or get-

ting an E/M code. We will look at the newest addition to EE+ called Essential Evidence and

the valuable Decision Support Calculators.

Essential EvidenceEssential Evidence

Essential Evidence is the unique, easy-to-use resource of Essential Evidence Plus. It com-

prehensively and concisely covers the most common conditions and diseases. It collects

and synthesizes the best available evidence in one place. All content is richly hyper-

linked to the other evidence-based medicine resources within Essential Evidence Plus

including the decision support tools, diagnostic calculators,

Cochrane Abstracts, POEMs, and practice guidelines. Con-

tinuously updated, Essential Evidence follows the latest de-

velopments in clinical medicine and brings evidence into

practice.

Purpose: A quick, comprehensive evidence-based reference to

assist clinicians with clinical questions concerning diagnosis

and treatment at the point of care.

Example: Clinicians can use Essential Evidence to not only

save time but more importantly improve health outcomes,

efficiency, and treatment because it makes the best availa-

ble evidence accessible in one place by topic.

Detailed Description: Essential Evidence Plus is designed to

join the best available evidence in a single database. Es-

sential Evidence summarizes the best available evidence on

many common clinical topics, providing information about

prevention, screening, symptoms, treatment, prognosis,

and more.

3.3. 4.4.

Answer to Question:

No, Depakote is not more

effective than Inderal.

Level Of Evidence

(LOE):

1b = one randomized con-

trol trial with narrow confi-

dence interval

Resource Type: InfoPOEM

Essential Evidence on Migraine

21

Decision Support ToolsDecision Support Tools

These calculators are truly decision support tools in that they influence how a case is

managed. Examples might include the Ottawa Ankle Rule calculator below that tells

whether an x-ray is necessary for an ankle sprain or a calculator that assigns the NIH

Stroke score.

The complete Essential Evidence Plus database is available on either the web, desktop or

the mobile versions. Essential Evidence Plus has a large number of calculator like tools

which can be incorporated into the decision making process of the clinical encounter. Let’s

look at each of these types of tools.

Decision Support Tools

More than 225 calculators are provided that are designed to help estimate the

likelihood of a diagnosis, calculate a patient’s risk for disease, estimate a prognosis, or

calculate a drug dose.

Purpose: To support the clinical decision making of a healthcare professional by offering

risk and probability assessments

Example: The clinical decision rules can help evaluate patients

with ankle sprains, (Ottawa Ankle Rule at right), estimate the

risk of stroke in patients with atrial fibrillation, or assist in

determining doses of drugs like warfarin.

Detailed Description: These clinical decision rules are created

based on results of valid and relevant studies. Each calculator

has a more information button that references the study and

outlines its characteristics. Each calculator asks users to

provide patient information and leads to a result that is

specific for the patient. From http://www.infopoems.com/support/ProductManual/IR_Databases.pdf

Finding the Decision Support Tools

On the mobile device, pick Decision Support Tools. The

categories are somewhat different from the systems that are

used in the Browse screen. There are so many cardiovascular

calculators that these have been divided up into ten separate

categories. At right, see the

Neurology calculators.

Ottawa Ankle Rule Musculoskeletal: Need

for Imaging Section

22

Dementia search

Decision Support

Tools and Calculators

Refine by Resource

Cochrane NGC Guideline

Refine by Topic Refine Results

23

Select DynaMed from the Library webpage list of resources.

DynaMed is a huge, evidence based reference designed to provide the most useful and cur-

rent disease information at the point-of-care for health care professionals. Where available,

links are provided to full-text electronic resources, including all FSU-available e-journals

via a PubMed reference and patient education handouts. Information on diseases and con-

ditions are orga-

nized into catego-

ries for ease of use

and quick answers

to clinical questions.

In addition to dis-

ease information,

there are mono-

graphs on medical

topics of interest

such as the cost of

medications and

procedures.

DynaMed - Web Version

Main Web Page

Type in Topic

To find a topic, you can either use the alphabet to browse to the topic or type the topic into

the Search box. The Search function will pull up a list of all the monographs that contain

the word or phrase you typed.

Pick Letter

Or

Select Topic Desired

24

Example: Otitis Media

Select Topic Desired

Expand

Category of Interest

Expand

All Categories

Or

Bottom Line Evidence Bold Level of Evidence

Link to full text Cochrane

article or PUBMED abstract

DynaMed continued...

25

The topic monograph opens to

the Causes, Risk Factors sec-

tion. (Figure 4) Monographs

are divided into categories/

sections for ease of use similar

to the web site. You can pull

up the Sections list by tapping

the little box with the arrow

next to the Section Title.

(Figure 5) Each of the major

sections for a topic is divided

into subsections to further fa-

cilitate finding the answer to

specific clinical questions

quickly. To see the subsec-

tions once into a major sec-

tion, tap Click Here to View

Outline.

DynaMed — Mobile Version

DynaMed is a huge, evidence-based disease reference that has been popular on the web

for years. Systematic surveillance of the medical literature by an army of editors is used to

keep DynaMed constantly updated. The mobile app was released in October of 2005. It

uses Skyscape’s Medical Library interface, so using it is easy for those familiar with this

interface. There are some tricks to navigation which we will cover in this handout. It is

also available in the new OMNIO app from Skyscape.

When you first open DynaMed, it takes you to the Index page. (Figure 2) If the pro-

gram opens in the Table of Content, tap the Index button to return there. On the Index

page, tap in the Look for: box and use the keyboard to put in GERD. The index will jump

to that spot in the list. Tap on GERD in the Index list. Since the monograph is under a

different name, it will give you a choice of possible matching topics. (Figure 3) Tap gas-

troesophageal reflux disease.

05/13/2014

Figure 1

Drop down Categories Navigation Pane

Figure 2 Figure 3

Figure 4 Figure 5